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Even before the growing needs of the rapidly swelling ranks of senior citizens became part of the national consciousness, Vanderbilt University was already laying the groundwork for geriatric care in both the educational and clinical setting.

At the behest of medical students 25 years ago, Vanderbilt recruited James S. Powers, MD, to provide more insight into the specialized care of elderly patients.

Powers, an associate professor in the division of Internal Medicine and Public Health, is double board certified in geriatrics and internal medicine. He serves as medical director for Vanderbilt Senior Care Service, director of the medical school’s fellowship program in geriatrics, chief of geriatric services at Nashville Veterans Administration Hospital, and principal investigator for the Vanderbilt-Reynolds Geriatrics Education Center.

Powers said the field of geriatrics is a relatively new specialty in the United States.

“I had the opportunity to help write questions for the first certifying exam in 1988,” he said. “Formal training in geriatrics had started just a few years before with the Veterans Administration in 1975.”

Powers credited Vanderbilt with being attuned to demographic trends and having the foresight to begin their programming when the field was still in its infancy.

“We know the population is aging worldwide,” he said. “In our country, we expect there will be a great increase … in fact as much as a doubling … in our elderly population over the next 20 years.”

Currently, 12 percent of the U.S. population is over the age of 65, but that number is expected to jump to 25 percent of the total population by 2030.

“The most rapidly growing age group in the population is those over the age of 85,” he continued, noting that there was a 125 percent increase in this population segment between the 1990 and 2000 Census data.

Powers added that while people are living longer, healthier lives, it doesn’t diminish the fact that with age comes the onset of disability. He said approximately 40 percent of people over age 65 have at least one disability, and many have multiple chronic illnesses.

“As we get older, we have less bounce back ability … less reserve. It’s important to be aware of that and to adjust your care,” he said. “The orthopedist is going to see more older people … the urologist, the same. The general surgeon will take out the gallbladder or appendix of older patients who also have heart disease, diabetes, etc. – so they all have to be aware of the interaction of chronic illnesses and other conditions.”

To make sure that caregivers are prepared, Powers said Vanderbilt now has providers in almost every discipline working with his team.

In July 2006, Vanderbilt was awarded a $2 million grant by the Donald W. Reynolds Foundation to create a comprehensive geriatric curriculum for providers … including medical students, residents and practicing physicians. Powers said the Vanderbilt-Reynolds Geriatrics Education Center used approximately half of the grant money to expand clinical training that was already underway. The other half of the grant deploys technology to improve training and care.

“The transformational change was to add informatics at the point of patient care through electronic records and also to help evaluate the training that was provided to the trainees,” he said.

Vanderbilt is one of 30 Reynolds geriatric centers nationwide. However, Powers said, another 10 awardees will soon be announced. Plans call for established centers to partner with new programs in a continuing effort to expand evidence-based geriatric training.

An extremely important element of care for the senior population, Powers continued, is the physical environment. In April of this year, Vanderbilt debuted ACE – Acute Care for the Elderly. The 14-bed unit houses a multidisciplinary team of physicians, nurses, physical therapists, nutritionists, pharmacists, social workers, case managers, patient care technicians and volunteers … all trained to deal with the special needs of elderly patients and their caregivers.

“It was developed as a model for geriatric care,” Powers said of the unit. “We hope that this model, too, will improve patient satisfaction and caregiver satisfaction … and we think patient safety and improved outcomes.”

In addition to work on the Vanderbilt campus, Powers also consults with the Center on Aging at Meharry. The partnership between the two medical schools began in 1990 and focuses on education in three key areas – physicians, nurses and nutritionists.

Educating more providers is rapidly becoming a necessity to meet demand that is just around the corner.

“We currently have approximately 3,000 geriatricians in the country. We need three times that many,” Powers said. “It’s a sad fact that there are approximately 150 fellowship positions available, and only about half of them are filled every year.”

However, Powers noted, there are opportunities to educate all providers … no matter what the specialty … on the additional care needs presented by an elderly patient population.

“Our goal is that every healthcare professional should be a good geriatrician for their own patients,” Powers concluded.

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